Salivary Gland Ducts Research Articles

Classification of submandibular salivary stones based on ultrastructural studies.

Sialolithiasis remains a clinical problem with unclear etiopathogenesis, lack of prevention methods, and only surgical treatment. An ultrastructure examination of submandibular sialoliths obtained from patients with chronic sialolithiasis was conducted using a scanning electron microscope and X-ray photoelectron spectroscopy. Based on the results, we divided sialoliths into three types: calcified (CAL), organic/lipid (LIP), and mixed (MIX). The core structure of the CAL and MIX is very similar. The core of the LIP has a prevalence of organic components. The intermediate layers' structure of the CAL is different from LIP and MIX. In LIP and MIX, the organic component begins to increase in intermediate layers rapidly. The structure of the superficial layers for all types of sialoliths is similar. We introduced a new classification of the submandibular salivary gland stones. Based on the results, it can be said that sialoliths type CAL and LIP have their separate path of origin and development, while MIX is formed as CAL stone, and the further pathway of their growth passes as LIP stones. Organic components were much more than inorganic in all layers of salivary gland stones, which highly prevents their dissolution in the patient's salivary gland duct.

FEATURES OF FETAL ANATOMY OF THE SUBMANDULAR DUCT

Knowledge of the patterns of the formation of the structure and topography of organs and systems of the human body is important for the interpretation of the true direction of the processes of organogenesis, the mechanisms of normal morphogenesis of organs, the emergence of anatomical variants and congenital defects. The interest in continuing the research was initiated by the buildup of an integrative approach in scientific developments, which, together with the doctrine of the individual anatomical variability of organs, systems and the shape of the human body, is the foundation of medicine. The next movement in this direction is the study of the variability of the shape of the submandibular strait of the human submandibular salivary gland during intrauterine development. Using the methods of macro-copy, microscopy, graphic and plastic reconstruction, fine preparation under the control of a binocular loupe, morphometry on 111 objects (60 before a person's fetus 7-12 weeks of intrauterine development and 51 fetuses of 4-10 months of intrauterine development were studied Variants of the form of the submandibular strait and the frequency of its manifestations in prenatal and human fetuses are from the rudiment of the tongue. At the beginning of the prefetal period of human ontogenesis, the rudiment of the gland increases significantly and takes the form of a continuous epithelial cord, which is represented by a large number of dividing cells. during the prefetal period with the rudiment of the submandibular duct of the submandibular salivary gland, a number of regular sequential changes occur: 1 – the formation of numerous epithelial cords of the II, III, IV order, as dichotomous branches from the main (main) epithelial anlage, 2 – the formation of a cavity (canal ) in the main epithelial bud and its ramifications of the II-IV order; 3 – the concentration of mesenchymal cells surrounding the epithelial cords (the formation of the mesenchymal part of the submandibular strait of the submandibular salivary gland) with its clear separation from adjacent tissues. In the group of objects of study, most often (76 cases, or 68.47%) there is a direct form of the submandibular ducts; the arcuate variant of the form of the submandibular ducts is almost three times less (26 cases, or 23.42%); as a variant of the form – the S-shaped form of the submandibular duct – was observed even less often (9 cases, or 8.11%).

Saliva NMR-Based Metabolomics in the War Against COVID-19.

COVID-19 is an emergent, worldwide public health concern. Joint efforts have been made by scientific communities of various fields to better understand the mechanisms of action of SARS-CoV-2. The need to understand the pathophysiological fingerprint and pathways of this disease make metabolomics-related approaches an indispensable tool for properly answering concerns relating to disease course. Determination of the metabolomic profile may help to explain the heterogeneous spectra of COVID-19 clinical phenotypes and be useful in monitoring disease progression as well as therapeutic treatments. In this sense, saliva has proven to be a strategic biofluid, owing not only to its appeal as a noninvasive sampling method but also due to the capacity of the virus to invade epithelial cells of the oral mucosa and salivary gland ducts via ACE2 receptors. Accordingly, important changes in metabolism have been described relating to COVID-19, indicating that metabolomics may open new avenues for understanding the pathophysiology of this disease, especially via longitudinal study designs. Thus, we discuss the importance of comprehending the SARS-CoV-2 salivary metabolomic fingerprint and also highlight the situation of Brazil on the frontlines of the war against COVID-19.

Coronavirus (COVID-19): the potential contamination among dentistry professionals in Brazil

The coronavirus (COVID-19) is considered a global pandemic with several respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The main symptoms of COVID-19 are fever, cough, and fatigue, while other symptoms include sputum production, diarrhea and alterations on the gastrointestinal system. The COVID-19 was recently identified in the saliva of infected patients and the transmission through of droplets and aerosols generated during clinical dental care is possible among dentists, oral health assistants and/or oral health technicians and others around the social cycle of the friendship of these health professionals, such as families and colleagues. Thus, there is very necessary to improve the several types of prevention to healthcare professionals that realize the liberation of aerosol during oral assistance. It’s important to mention that these precautions are important to prevent human-to-human transmission and protect the global system of health. In addition, this care is essential to decrease the spread of COVID-19 in this moment. Descriptors: Coronavirus Infections; Dentistry; Occupational Diseases.ReferencesLi LY, Wu W, Chen S, Gu JW, Li XL, Song HJ et al. Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective. J Dig Dis. 2020;21(4):199-204. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-73.Gabutti G, d'Anchera E, Sandri F, Savio M, Stefanati A. Coronavirus: update related to the current outbreak of COVID-19. Infect Dis Ther. 2020;9(2):1-13.Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J Virol. 2011;85(8):4025-30.To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JMC et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis. 2020;71(15):841-43.Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-21.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-69.Brazilian Ministry of Health. https://saude.gov.br/Brazilian Institute of Geography and Statistic. https://www.ibge.gov.br/Lauc G, Sinclair D. Biomarkers of biological age as predictors of COVID-19 disease severity. Aging (Albany NY). 2020;12(8):6490-91.Federal Council of Dentistry from Brazil. http://website.cfo.org.br/dados-estatisticos-de-profissionais-e-entidades-ativas-por-ano/Regional Dentistry Council of the State of São Paulo. http://www.crosp.org.br/intranet/estatisticas/estMunicipios.phpThompson RN. Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations. J Clin Med. 2020;9(2):498.

ROLE OF MAGNETIC RESONANCE IMAGING SIALOGRAPHY IN DIAGNOSIS OF SALIVARY GLAND DUCT DISEASES

Salivary gland duct diseases have been commonly addressed and investigated using ultrasound and conventional radiographic techniques. However, ultrasound assessment displays a limited view of the salivary ductal tree. While conventional X-ray or CT sialography may provide acceptable spatial anatomy, a number of drawbacks were reported, with complications such as trauma or acinar rupture and sepsis, and contraindications such as acute parotitis or contrast material allergy, not to mention the required high operator experience and patient compliance.MR sialography is a new nonionizing noninvasive technique that is being developed to evaluate diseases of the salivary ducts. Adequate assessment of the duct system is obtainable, with no involvement of invasive techniques, or contrast material or radiation exposure.MR sialography offers many advantages over alternative imaging techniques such as conventional x-ray sialography. These include the noninvasive technique; avoiding contrast media, ionizing radiation, and dependence on an experienced operator.Details provided by MRI sialography are considered to be of value for the interventional decision-making process. These details include the distance of the obstructing cause from the ductal punctum, the size and number of stones, ductal mapping and diameters, Upstream dilatation, and ductal condition.

Metabolic, Radiation, and Medication Induced Sialadenitis

This review will cover clinical presentations for sialadenosis, radiation-related sialadenitis, and medication-induced salivary disorders. Presentation of metabolic disorder–related sialadenosis or gland enlargement is gradual and progressive without obstructive salivary symptoms. In contrast, radioactive iodine therapy can induce acute and chronic sialadenitis due to salivary gland dysfunction and duct damage with subsequent duct stenosis. Obstructive symptoms associated with fluctuating gland swelling and pain can be treated with sialendoscopy and dilation of the main salivary ducts. Further investigation of radioprotective agents to prevent salivary gland damage from radioactive iodine and external beam radiation to the head and neck is necessary. Iodine contrast–induced sialadenitis and medications that may affect salivary function are also described. Metabolic disorders, medications, radiation, and iodine contrast can cause salivary gland dysfunction. Management of salivary gland swelling and obstruction depends on the cause of chronic sialadenitis.

A CHALLENGING DIAGNOSIS OF IDIOPATHIC VOLUMETRIC GROWTH IN THE SUBMANDIBULAR REGION

A 2-year-old white girl, accompanied by her mother, presented with a swelling in her face and 4 days of the same asymptomatic spontaneous volumetric growth. The mother denied comorbidities or weight loss. The extra-oral exam showed a 4-cm node in the right jaw angle progressing to the submandibular region, steady and painless during palpation. The intra-oral exam revealed normal features. The patient was referred to the hospital with hypothetical diagnosis of infantile cortical hyperostosis, lymphoma, and osteosarcoma. The hemogram showed neutrophilia and thrombocytopenia. Magnetic resonance imaging revealed hyperintensity in the submandibular lymph nodes of the jaw angle and normal aspects of the bones. The fine-needle aspiration of the submandibular region showed bacteria, neutrophils, and simple cuboidal and columnar epithelium-like salivary gland duct. The final diagnosis was lymphadenomegaly secondary to acute sialadenitis. The patient was treated with 7 days’ of oral amoxicillin/clavulanate. On the 14th day, we observed a complete tumoral remission. A 2-year-old white girl, accompanied by her mother, presented with a swelling in her face and 4 days of the same asymptomatic spontaneous volumetric growth. The mother denied comorbidities or weight loss. The extra-oral exam showed a 4-cm node in the right jaw angle progressing to the submandibular region, steady and painless during palpation. The intra-oral exam revealed normal features. The patient was referred to the hospital with hypothetical diagnosis of infantile cortical hyperostosis, lymphoma, and osteosarcoma. The hemogram showed neutrophilia and thrombocytopenia. Magnetic resonance imaging revealed hyperintensity in the submandibular lymph nodes of the jaw angle and normal aspects of the bones. The fine-needle aspiration of the submandibular region showed bacteria, neutrophils, and simple cuboidal and columnar epithelium-like salivary gland duct. The final diagnosis was lymphadenomegaly secondary to acute sialadenitis. The patient was treated with 7 days’ of oral amoxicillin/clavulanate. On the 14th day, we observed a complete tumoral remission.

Primary squamous cell carcinoma of the salivary gland: immunohistochemical analysis and comparison with metastatic squamous cell carcinoma.

BackgroundPrimary squamous cell carcinoma (SCC) of the salivary gland is a rare disease, and distinguishing primary SCC from metastatic SCC is difficult. This study investigated the histological and immunohistochemical differences between primary and metastatic salivary gland SCC to improve the accuracy of diagnosis and to explore the pathogenesis of this disease.MethodsData of 16 patients who underwent surgery for SCC of salivary glands between 2000 and 2018 at Asan Medical Center were retrieved. Eight patients had a history of SCC at other sites, and eight patients had only salivary gland SCC. Immunostaining for p16, p53, androgen receptor (AR), gross cystic disease fluid protein 15 (GCDFP-15), and c-erbB2, as well as mucicarmine staining, were compared between the two groups.ResultsMost tumors were located in the center of the salivary glands with extraparenchymal extension. The histology of primary SCC of the salivary gland was consistent with moderately differentiated SCC with extensive desmoplastic reaction and peritumoral inflammation. Involvement of the salivary gland ducts and transition into the ductal epithelium were observed in two cases. Metastatic SCC resembled the primary tumor histologically and was associated with central necrosis. Both groups exhibited negative mucin staining. Two, one, and one primary SCC case exhibited AR, GCDFP-15, and c-erbB2 positivity, respectively.ConclusionsA subset of primary SCCs originated in salivary ducts or was related to salivary duct carcinoma. Distinguishing primary from metastatic SCC of the salivary gland is difficult using histologic features and immunoprofiles. A comprehensive review of the medical history is essential.

Surgical method for treating ductal sialadenitis of the large salivary glands

The authors indicated that pronounced deformities of the ducts of the large salivary glands occur in 70% of patients with chronic sialadenitis. Due to the fact that conservative treatment of ductal sialadenitis, especially pronounced, does not give long-term results, the authors proposed various methods of surgical treatment of ductal sialadenitis, which have a low level of trauma of collateral tissues and provides a stable long-term result.

Repertoire Analysis of B-Cells Located in Striated Ducts of Salivary Glands of Patients With Sjögren's Syndrome.

A major complication of primary Sjögren's syndrome (pSS) is development of mucosa associated lymphoid tissue (MALT) B-cell lymphoma, particularly in salivary glands. These lymphomas express FcRL4 and are characteristically associated with lymphoepithelial lesions. Neoplastic B-cells may be derived from non-neoplastic glandular intraductal B-cells, also virtually all expressing FcRL4. A characteristic feature of MALT lymphomas is the production of rheumatoid factors (RFs), which are largely encoded by stereotypic immunoglobulin variable heavy chain (IGHV) sequences. The aim of this study was to examine whether there is a relationship between the intraductal and periductal B-cells and whether the intraductal B-cells are selected for RF. RNA was extracted from laser-microdissected infiltrated ductal areas and periductal infiltrates from frozen parotid gland tissue sections of 5 pSS patients. PCR amplified IGHV transcripts were cloned into pCR™4-TOPO vector and subsequently sequenced. Microdissected ducts yielded 96 unique IGHV sequences derived from intraductal B-cells, while 119 unique IGHV sequences were obtained from periductal infiltrates. No major difference in VH-gene usage was observed between intraductal and periductal B-cells. Nearly all (>90%) IGHV sequences derived from both intraductal and periductal B-cells were mutated. Clonal expansions as defined by shared VDJ rearrangements were also present among both intraductal and periductal B-cells: in total 32 clones were found, from which 12 were located within ducts, 15 in periductal areas, and five clones shared members in both areas. We observed 12 IGHV rearrangements encoding for RF sequences from which two were derived from intraductal B-cells and 10 from periductal B-cells. Nine RF sequences were part of a clone. Together these findings indicate that intraductal and periductal B-cells are closely related to each other. Intraductal B-cells are most likely derived from periductal B-cells. We did not obtain evidence that RF-specific B-cells are enriched within the striated ducts. We speculate that in principle any activated B-cell can enter the striated ducts from the periductal infiltrate, irrespective of its antigenic specificity. Within the ducts, these B-cells may receive additional activation and proliferation signals, to further expand at these sites and by acquisition of driver-mutations develop toward lymphoma.

Does infection of 2019 novel coronavirus cause acute and/or chronic sialadenitis?

2019 novel coronavirus (2019-nCoV) is widespread in China and other countries. The target of 2019-nCoV and severe acute respiratory syndrome coronavirus (SARS-CoV) is angiotensin-converting enzyme 2 (ACE2) positive cells. ACE2 is present in the salivary gland duct epithelium, and thus it could be the target of 2019-nCoV and SARS-CoV. SARS-CoV-related animal model experiments show that it can infect the epithelial cells on the salivary gland duct in Chinese rhesus macaques by targeting ACE2. Clinical studies confirmed that 2019-nCoV and SARS-CoV could be detected in saliva of human patients. We hypothesize that the infection of 2019-nCoV and SARS-CoV will lead to inflammatory pathological lesions in patients’ target organs, and possibly inflammatory lesions in salivary glands. 2019-nCoV may cause acute sialoadenitis in the acute phase of infection. After the acute phase, chronic sialoadenitis may be caused by fibrosis repairment. Although there was no direct evidence to prove this, the available indirect evidence indicates a high probability of our hypothesis.

Different expression and subcellular localization of vesicular inhibitory amino acid transporter in ducts of major salivary glands: An in situ study in mice

ObjectiveThe aim of this study was to clarify the mechanism of GABA (□-amino butyric acid)-signaling in the salivary glands by localization of vesicular inhibitory amino acid transporter, a key molecule in GABA-synthesis. DesignParotid, sublingual and submandibular glands of mice at various postnatal stages were examined in immuno-light and electron microscopy as well as immuno-blotting. ResultsExpression for vesicular inhibitory amino acid transporter was detected in parotid and sublingual glands of both sexes and female submandibular gland throughout postnatal development, while it was negligible in male submandibular glands at and after puberty. The expression in female submandibular glands attenuated after testosterone injection. The immunoreactivity was localized in striated ductal cells, but not acinar cells, in the salivary glands, and it occurred in association with intracellular and plasma membranes of the cells. It also occurred in myoepithelial and vascular smooth muscle cells. ConclusionsGABA-signaling was suggested to be a significant signaling pathway in salivary ductal cells, which was suppressed in male submandibular glands at and after puberty. The suppression in the submandibular duct was by testosterone. In addition, the participation of vesicular inhibitory amino acid transporter in GABA signaling through plasma membranes of the ductal cells was suggested. The significance of occurrence of the immunoreactivity in myoepithelial and smooth muscle cells remains to be further elucidated in terms of implication in GABA signaling.

A case of carcinoma ex pleomorphic adenoma occurred in the sublingual gland

AbstractCarcinoma ex pleomorphic adenoma is a malignant salivary gland mixed tumor arising from an existing pleomorphic adenoma (PA). Less than 1% of cases occur in the sublingual gland. Salivary gland duct carcinomas (SDCs) also exhibit invasive development and are rarely found as a microinvasive lesion. A 47‐year‐old man complained of swelling of the oral floor during general dental treatment and was referred to our department. Excision was performed, and we histopathologically determined an early stage of SDC ex PA confirmed in the PA. Tumor from sublingual gland should be carefully treated in consideration of malignancy.

Radyolojik bulgularla submandibular bezde dev siyalolit: Olgu sunumu

<p class="ql-align-justify">A sialolith is defined as one or more calcific foci in oval or round form within a parenchyma or duct of a salivary gland. It is most commonly seen in the submandibular salivary gland and in the 30-60 age range. A 46-year-old male patient was admitted to the Department of Oral and Maxillofacial Radiology of Istanbul University Faculty of Dentistry for dental treatment.&nbsp;A panoramic radiography incidentally showed a radiopaque formation in the right mandible angulus. No symptoms were detected in the clinically relevant region. A cone beam computed tomography showed a mixed, hyperdense focus in the lingual area in the right angulus region and a sialolith was detected. On ultrasonography, a sialolith was found in submandibular salivary gland duct. Due to the absence of any symptoms, regular followup was provided. The determination of localization and size of the sialolith with clinical and radiographic findings are important in treatment planning. In this case report, we aimed to present the radiological findings of an asymptomatic case of a large sialolith.

Morphological differences between regenerating salivary glands after salivary gland duct ligation and embryonic salivary glands

BackgroundMost animals and organs have regenerative capabilities. Whether regeneration is a developmental process or a distinct phenomenon that is independent of development is debatable. MethodWe examined the differences between developing and regenerating salivary glands using duct-ligation models. We performed morphological analyses comparing submandibular gland regeneration and development. To reveal the proliferation processes that occur during salivary gland regeneration and development, we counted the number of Ki67-positive cells over time. In addition, we examined the expression of the following markers: aquaporin 5, smooth muscle actin, cytokeratin 7, and tubulin beta 3. ResultThe proliferation patterns seen during regeneration differed from those observed during development. Different salivary gland marker expression patterns were seen during development and regeneration. ConclusionThis study showed that regenerating salivary glands do not follow the same growth process as developing salivary glands.

VDR in salivary gland homeostasis and cancer

The vitamin D receptor (VDR) and its ligand 1,25(OH)2D3 (1,25D) impact differentiation and exert anti-tumor effects in many tissues, but its role in salivary gland has yet to be defined. Using immunohistochemistry (IHC), we have detected strong VDR expression in murine and human salivary gland ducts. Compared to normal gland, VDR protein expression was retained in differentiated human pleomorphic adenoma (PA) but was undetectable in undifferentiated PA and in carcinomas, suggesting deregulation of VDR during salivary cancer progression. To gain insight into the potential role of VDR in salivary cancer, we assessed the effects of vitamin D in vivo and in vitro. Despite the presence of VDR in salivary gland, chronic dietary vitamin D restriction did not alter morphology of the salivary epithelium in C57/Bl6 mice. The localization of VDR in ductal epithelium prompted us to examine the effects of 1,25D in an established cell line (mSGc) derived from normal murine submandibular gland (SMG). This previously characterized cell line consists of multiple stem, progenitor and differentiated cell types as determined by mutually exclusive cellular expression of basal, ductal and myoepithelial markers. We demonstrated VDR expression and regulation of VDR target genes Vdr and Postn by 1,25D in mSGc, indicating functional ligand-mediated transcriptional activity. The effect of VDR signaling on epithelial differentiation markers was assessed by qPCR and IHC in mSGc cells treated with 1,25D. We found that 1,25D reduced mRNA expression of the basal cell progenitor marker keratin 5 (K5) and increased expression of the differentiated ductal cell marker keratin 7 (K7). Further, we found that 1,25D significantly decreased the number of proliferating cells, including proliferating K5+ cells. Characterization of cell cycle by Muse cytometry indicated 1,25D treatment decreased cells in S, G2, and M phase. The inhibition of K5+ cell proliferation by 1,25D is of particular interest because K5+ basal cells contribute to a wide variety of salivary tumor types. Our studies suggest that 1,25D alters cancer-relevant progenitor and differentiation markers in the salivary gland.

Necrotizing sialometaplasia: a case report of a non-ulcerated histopathological presentation

A 27-year-old woman presented with the chief complaint of severe pain in the palate region, which had been present for two months. Upon examination, she was found to have a firm, non-ulcerated nodule measuring about 2.5cm at the palatal junction. Incisional biopsy was recommended because the clinical differential diagnosis was mucoepidermoid carcinoma or squamous cell carcinoma. Anatomopathological examination revealed squamous metaplasia of the salivary gland ducts with preservation of the lobular architecture. Immunohistochemistry showed metaplastic ducts with low reactivity for p53 and Ki67, as well as positivity for CK AE1/AE3, CK7, p63, S-100, and SMA. The final diagnosis was necrotizing sialometaplasia. No treatment is required for this disease. Thirty-nine days after biopsy, total remission was observed with no signs of relapse after two years.

SMARCB1/INI1 AND NUT IMMUNOEXPRESSION IN A LARGE SERIES OF ORAL AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMAS

Objective Current evidences support that squamous cell carcinomas (SCCs) of the oral cavity (OSCC) and oropharynx (OPSCC) are distinct and unique, with differences on its pathogenesis, treatment, and prognosis. SMARCB1/INI1 is a potent tumor suppressor, whereas nuclear protein in testis (NUT) antibody identifies midline carcinoma (NMC), a rare aggressive carcinoma typically located on the midline of the head and neck. Although with different clinicopathological features, OPSCC and NMC share anatomic location. Interestingly, the SMARCB1/INI1 and NUT expression profile in OSCC and OPSCC is unknown. Study Design The immunohistochemical analysis of SMARCB1/INI1 and NUT antibodies were performed on tissue microarrays containing 108 OSCC and 52 OPSCC formalin-fixed paraffin-embedded samples. Results Only 3 cases (2 OSCC and 1 OPSCC) were SMARCB1/INI1 negative, whereas 3 cases (2 OPSCC and 1 OSCC) were NUT positive. Moreover, SMARCB1/INI positivity was observed in surface epithelium, endothelial cells, mononuclear inflammatory cells, salivary gland ducts and sebaceous gland acini, whereas 7 cases with only intense cytoplasmic staining for NUT were considered nonspecific. Conclusions Our results show that SMARCB1/INI1+/NUT- immunoexpression profile is prevalent when assessing OSCC and OPSCC. However, it is recommended to analyze these antibodies, because of the prognostic effect of identifying SMARCB1/INI1-deficient SCC and NMC cases. FAPESP (2016/11419-0). Current evidences support that squamous cell carcinomas (SCCs) of the oral cavity (OSCC) and oropharynx (OPSCC) are distinct and unique, with differences on its pathogenesis, treatment, and prognosis. SMARCB1/INI1 is a potent tumor suppressor, whereas nuclear protein in testis (NUT) antibody identifies midline carcinoma (NMC), a rare aggressive carcinoma typically located on the midline of the head and neck. Although with different clinicopathological features, OPSCC and NMC share anatomic location. Interestingly, the SMARCB1/INI1 and NUT expression profile in OSCC and OPSCC is unknown. The immunohistochemical analysis of SMARCB1/INI1 and NUT antibodies were performed on tissue microarrays containing 108 OSCC and 52 OPSCC formalin-fixed paraffin-embedded samples. Only 3 cases (2 OSCC and 1 OPSCC) were SMARCB1/INI1 negative, whereas 3 cases (2 OPSCC and 1 OSCC) were NUT positive. Moreover, SMARCB1/INI positivity was observed in surface epithelium, endothelial cells, mononuclear inflammatory cells, salivary gland ducts and sebaceous gland acini, whereas 7 cases with only intense cytoplasmic staining for NUT were considered nonspecific. Our results show that SMARCB1/INI1+/NUT- immunoexpression profile is prevalent when assessing OSCC and OPSCC. However, it is recommended to analyze these antibodies, because of the prognostic effect of identifying SMARCB1/INI1-deficient SCC and NMC cases. FAPESP (2016/11419-0).

Saliva a mirror to oral health in neurofibromatosis type-1 patients

Background Neurofibromatosis (NF) consists of a complex group of syndromes, which occur as a result of inactivation of the various tumor suppressor genes precipitating multiple cutaneous neuromas and schwannomas in the body. Neurofibromatosis type 1 (NF1)/Von Recklinghausen disease/Watson disease affects 1 in 30,000 individuals and is caused by a mutation in the tumor suppressor gene NF1, locus 17 q11.2; this is one of the largest genes in the human genome and is inherited in an autosomal dominant pattern. Case Summary A cross-sectional study was conducted in a family suffering from NF over 3 generations, consisting of 20 members, and those meeting the diagnostic criteria for NF1 according to the National Institutes of Health (Stumpf et al., 1988) were selected. Pedigree analysis, clinical examination, Ramfjord periodontal index, and sialometry were performed for the following parameters: (1) salivary flow rate—whole unstimulated saliva was considered for salivary flow rate, which was measured by asking the patient to spit out saliva into a sterile container and the amount of saliva is quantitatively measured; (2) salivary pH—salivary pH of whole unstimulated saliva was measured by using the pH meter; (3) salivary alpha amylase activity—this was measured by using the starch–saliva–iodine test. Conclusions On clinical examination, all the members of the family showed distinctive osseous lesions at the base of the tongue. Salivary analysis revealed decreased salivary flow rate and increased pH, making the individuals prone to periodontitis caused by decreased clearance and enzymatic activity. Alterations in the salivary glands (acini and ducts) is caused by mutations in the NF1 gene. Neurofibromin is known to play important role in salivary glands cell division and differentiation via the Rho–rock–LIM kinase-2 pathway; hence the defect in neurofibromin results in defective salivary gland cell differentiation, causing nonfunctional cells and making the individual prone to hyposalivation.

MICROMARSUPIALIZATION AS TREATMENT OF CHOICE FOR RANULA IN LACTATING

Ranula is a common lesion of the mouth floor, resulting from rupture of the salivary gland duct and extravasation of mucin, usually associated with local trauma. Higher prevalence among young people and children is observed. Treatment options include marsupialization, excision of the gland involved, and micromarsupialization, the less invasive technique. A 28-year-old lactating female patient without previous oral lesions was complaining of lump in the mouth. Intraoral examination showed a bluish-floating increase of volume in the right mouth floor crossing midline, associated with ulcer near the occlusion line, with clinical diagnosis of ranula. Micromarsupialization was the treatment of choice, and after 8 months, there was complete regression of the lesion without recurrence. This technique is a good treatment option because of its simplicity of execution and low invasiveness, being prioritized in patients like the one from this case report.